Provider Demographics
NPI:1851486773
Name:LATTIMER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:LATTIMER CHIROPRACTIC CLINIC
Other - Org Name:BRIAN J LATTIMER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATTIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-472-6393
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-0551
Mailing Address - Country:US
Mailing Address - Phone:304-472-6393
Mailing Address - Fax:304-472-6485
Practice Address - Street 1:RT 20 PROFESSIONAL ARTS PLAZA
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-0551
Practice Address - Country:US
Practice Address - Phone:304-472-6393
Practice Address - Fax:304-472-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2203014000Medicaid
WVSP00151Medicare PIN